South Africa has made significant progress in improving maternal and perinatal health in recent decades. The introduction of universal access to antenatal care with the 8-visit schedule improved human immunodeficiency virus (HIV) clinical management and expansion of emergency obstetric services, contributing to significant reductions in maternal and neonatal morbidity and mortality. However, challenges still exist, as rates of preterm births, hypertensive disorders of pregnancy and stillbirths remain high, particularly among disadvantaged communities.¹

One of the reasons for the need for greater progress is that most interventions continue to focus narrowly on the pregnancy period itself. By the time a woman presents for her first antenatal visit, many of the risks for adverse outcomes have already been established, often years before conception. To decrease negative outcomes further, the need to move beyond episodic pregnancy care and adopt a life-course approach to women’s health, with an emphasis on preconception and interconception care, is required.

South Africa, like many low- and middle-income countries (LMICs), is now facing a double burden of disease, rising rates of non-communicable diseases alongside ongoing infectious disease challenges. Increasing numbers of women of reproductive age are entering pregnancy with obesity, diabetes, hypertension and HIV – conditions that significantly raise the risk of maternal and neonatal complications.² Moreover, many women experience short inter-pregnancy intervals, unresolved complications from previous pregnancies and undiagnosed mental health issues.³ In addition, the postpartum period is often a neglected window for continuing healthcare, with limited follow-up or structured support. As a result, opportunities to promote recovery and reduce the risk of recurrence of medical conditions are missed.

Preconception care and interconception care provide a framework to address these gaps. Preconception care includes health promotion, screening for chronic diseases and infections, nutritional interventions and reproductive life planning provided prior to pregnancy.⁴ Interconception care focuses on improving health between pregnancies, with emphasis on birth spacing, mental health and managing prior medical and socio-economic issues.⁵

Both forms of care (preconception and interconception care) share a common goal: to prepare women for healthy pregnancies and to improve their long-term health.

Despite the clear benefits, preconception and interconception care remain underdeveloped in South Africa. Several barriers persist:

There is an urgent need for policy and programmatic action to strengthen preconception and interconception care in South Africa:

In the Netherlands, Healthy Pregnancy 4 All has been established to improve pregnancy outcomes. There are two obstetric interventions, one before pregnancy (programmatic preconception) and one during pregnancy (systematic antenatal risk assessment).⁸ This intervention would be suitable to try in a South African setting, as this study used it in geographical areas with high adverse perinatal outcomes. During the intervention, community-based primary providers, such as general practitioners and midwives, provide preconception care consultations. There are two sessions in these consultations. The woman completes a questionnaire before the first session. This questionnaire examines risk variables in the following areas: family, work and/or environment, medical history, obstetric and/or gynaecologic history, lifestyle and background. A history of possible risk factors is obtained during the consultation, and the pregnant woman develops an intervention strategy to lessen or eliminate risk factors. A follow-up visit is scheduled for 3 months later to assess compliance with the intervention plan.

The World Health Organization (WHO) created a life-course approach to sexual and reproductive health. This is guidance on preconception and interconception care as a core life course for sexual reproductive health (SRH) and mother, newborn, child and adolescent health (MNCAH).⁹ In South Africa, a practical implementation blueprint can be used:

To further reduce maternal and neonatal mortality, South Africa must move beyond a narrow focus on antenatal care and embrace a life-course approach that addresses women’s health before, between and after pregnancies. Preconception and interconception care for both women and men should be recognised as essential components of comprehensive maternal and neonatal health services; integration of these components into primary care and community engagements are the next critical steps in improving the long-term well-being for women and their families.